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Fine Wine or Sour Milk


The passage of time is both friend and foe.  Time allows grape juice to mature into wine, but it can also turn milk sour and cause bread to become stale.  Time can create master clinicians or, in the case of chiropractors who do not remain current in their knowledge, out-of-date chiropractors. Time can make us wise or just make us older. 


There is a general belief that physicians become better with time and experience.  Most of us have believed that physicians accumulate knowledge and skill with the passing of years and become better doctors.   However, research does not support this belief. Surprisingly, a recent systematic review of 62 studies revealed that in 70% of the studies there was a negative association between length in practice and several indicators of good performance.[1] (Of course this metanalysis evaluated trends in medical doctors and not chiropractors, but the possibility that this trend could apply to chiropractors should cause chiropractors to take note.) Doctors who have been in practice longer are at risk of providing lower quality care and should be targeted for performance improvement interventions. 


Unless you deliberately commit yourself to remain current in scientific trends and modern standards of practice, you will most certainly be left behind.  If you do not continually seek to improve the quality of the care that you provide, then it may be indicative of the low value that you place on your patients.  It takes effort to remain current and relevant, and most of us are resistant to change.  It is easier to reject guidelines and outcome measures than to take the time to understand why we need them and how they are created.


Where do you stand?


Are you maturing into a fine wine, or are you becoming sour milk? Are you using clinical guidelines, outcome measures, informed consents, and the safest methods available?  Are you evaluating general health indicators, promoting prevention and public health, and limiting your patient’s exposure to radiation?  Are you well-versed in risk management?  How do you measure up?


How can we improve with time?


Seek knowledge. Reject passivity.   If you are interested in improving your practice quality with each passing year, then you need to have a purposeful plan.  This plan must be flexible and allow for changes in universal practice standards.   Start by learning what the current standards of care are in the various aspects of practice, (patient safety, outcome measures, chiropractic practice, risk management…) and then critically evaluate your practice, identify shortcomings and then make a plan to align your practice with modern standards.


Life-Long Learning


If this is the first time that you have heard the phrase Life-Long Learning, let me assure you that it will not be the last.  The vast volumes of new information that is becoming available makes a doctor’s formal schooling obsolete in just a few years.  The education of everyone in healthcare is destined to be a lifelong pursuit and gone are the days (if those days ever really existed) when a doctor could master a topic and then rest on his or her laurels.  Several state boards have already identified the concept of Life-Long Learning and are seeking to expand the hours required for re-licensure and are dictating required topics such as risk management, x-ray, chiropractic technique and public health. We all need to work hard to keep up with the ever-expanding body of knowledge and ever-changing standards of care if we desire to remain relevant.

[1] Choudhry NK, et al. Systematic review: the relationship between

clinical experience and quality of health care. Annals of Internal Medicine 2005; 142: 260–273